Erector spinae plane block vs interscalene brachial plexus block for postoperative analgesia management in patients who underwent shoulder arthroscopy

Background Interscalene brachial plexus block (ISB) is the gold standard method used for postoperative analgesia after arthroscopic shoulder surgery. Ultrasound guided erector spinae plane block (ESPB) is an interfascial plane block. The aim of this study is to compare the analgesic efficacy of ESPB and ISB after shoulder arthroscopy. The primary outcome is the comparison of the perioperative and postoperative opioid consumptions. Methods Sixty patients with ASA score I-II planned for arthroscopic shoulder surgery were included in the study. ESPB was planned in Group ESPB (n = 30), and ISB was planned in Group ISB (n = 30). Intravenous fentanyl patient-controlled analgesia was administered to both groups in the postoperative period. Intraoperative and postoperative opioid and analgesic consumption of both groups, side effects and complications related to opioid use, postoperative pain scores and rescue analgesic use were recorded in the first 48 h postoperatively. Results Pain scores were significantly higher in the ESPB group in the first 4 h postoperatively than in the ISB group (p < 0.05). The total fentanyl consumption and number of patients using rescue analgesics in the postoperative period were significantly higher in the ESPB group (p < 0.05). The incidence of nausea in the postoperative period was significantly higher in the ESPB group (p < 0.05). Conclusions In our study, it was seen that ISB provided more effective analgesia management compared to ESPB in patients underwent shoulder arthroscopy surgery

Does pelvic injury trigger erectile dysfunction in men?

WOS: 000442089500008PubMed ID: 26764545Purpose: Pelvic ring fractures constitute 3%-8% of all fractures of the skeletal system and are generally related with high energy trauma. Sexual dysfunction following pelvic fracture has a high incidence, and affects the male patients both physically and psychologically. In this study, we aimed to investigate the impact and frequencies of comorbidities such as erectile dysfunction (ED) with adverse sociocultural and psychological consequences for the patient who had a pelvic ring fracture. Methods: This study included 26 men who corresponded to the inclusion criteria and agreed to participate our study. Results: According to fracture types, most of our cases were Tile type A1 and type A2. Severe and moderate ED were detected in 46.1% (12/26) of these patients via the International Index of Erectile Function-5 questionnaire. Conclusion: ED develops following pelvic fractures, especially in Tile type B and C pelvic fractures

A comparison of adductor canal block before and after thigh tourniquet during knee arthroscopy: A randomized, blinded study

Background: Adductor canal block (ACB) provides effective analgesia management after arthroscopic knee surgery. However, there is insufficient data about performing ACB before or after inflation of a thigh tourniquet. We aimed to investigate the efficacy of ACB when it is performed before and after thigh tourniquet and evaluate motor weakness. Methods: ACB was performed before the tourniquet inflation in the PreT group, it was performed after the inflation of the tourniquet in the PostT group. In the PO group, ACB was performed at the end of surgery after disinflation of the tourniquet. Results: There were no statistical differences between the groups in terms of demographic data. Opioid consumption showed no statistically significant differences (for total consumption; p = 0.5). The amount of rescue analgesia administered and patient satisfaction were also not significantly different between groups. There was no significant difference in terms of static and dynamic VAS scores between groups (for 24 hours; p = 0.3, p = 0.2 respectively). The incidence of motor block was higher in the PreT group (eight patients) than in the PostT group (no patients) and in the PO group (only one patient) (p = 0.005). Conclusions: Using a tourniquet before or after ACB may not result in any differences in terms of analgesia; however, applying a tourniquet immediately after ACB may lead to muscle weakness

EFFECTIVENESS OF SUPERVISED RESISTIVE EXERCISE AND HOME-BASED EXERCISE TRAINING ON LOWER LIMB MUSCLE STRENGTH IN PATIENTS WITH KNEE OSTEOARTHRITIS: A LONG-TERM COMPARATIVE STUDY

World Congress of the Osteoarthritis-Research-Society-International (OARSI) on Osteoarthritis -- MAR 31-APR 03, 2016 -- Amsterdam, NETHERLANDSWOS: 000373538800849Twenty-six patients with knee OA (Kellgren & Lawrence grade 2 or 3), aged 53,86 ± 5,33 years participated in this study. All of the patients were informed about OA risk factors, pathogenesis, prognosis, modification of daily living activities during a 2-hour long patient education lecture. Participants were then assigned at random to one of two groups as home-based strength training group (HEG) (n ¼ 13) and resistive exercise training group (REG) (n ¼ 13). Both exercise programs include the same or similar exercises and aimed at increasing lower limb strength (hip, knee and ankle muscles). All subjects performed three months exercise training. The subjects in the HEG were given strength exercise training and instructed to perform the exercise program three times a week for three months at home. And also, they received one session monthly supervised exercise training for progression. Progression in exercise training obtained with elastic bant. The REG received a supervised program three times a week for three months at indoor resistive exercise station. Patients in both groups performed 10 minutes warm-up period and cool-down period. The strength of quadriceps femoris, hamstrings, hip abductors, hip adductors, and gastrocnemius muscles assessed by using handheld dynamometry by the same investigator. Muscle strength of participants was assessed at baseline, 12 weeks and 24 weeks (follow-up).Osteoarthritis Research Society Internationa

Postmenapozal osteoporozlu hastalarda zoledronik asit infuzyonunun olumsuz etkileri

Objective: Renal toxicity and hypocalcemia are two commonest adverse effects of zoledronic acid reported in cancer patients with bone metastasis. Similar data are lacking in postmenopausal women with osteoporosis treated with zoledronic acid infusion. We aimed to evaluate the effects of annual treatment of postmenopausal osteoporotic women with intravenous infusion of zoledronic acid on their renal and hepatic functions. The effects of the drug on the biochemical parameters of the patients were also assessed.Methods: We reviewed the electronic medical records (EMRs) of postmenopausal women with osteoporosis treated with 5 mg of zoledronic acid once in a year. Changes in the serum levels of calcium, phosphorus, alkaline phosphatase, creatinine, blood urea nitrogen (BUN) as well as alanine and aspartate transaminases were determined after infusing zoledronic acid relative to the base line results. Information about the documented adverse effects of zoledronic acid were extracted from the EMRs. Results: All the biochemical parameters, except calcium, demonstrated no statistically significant changes in their serum levels when the results, before and after treatment with zoledronic acid, were compared. The serum Ca level slightly and significantly decreased from 9.6&plusmn;0.6 mg/dl (before treatment) to 9.4&plusmn;0.9 mg/dl (after treatment) (p=0.018). A few but important adverse effects associated with zoledronic acid infusion in the patients were influenzalike symptoms (6), myalgia (4), arthralgia (4), headache (4), and pyrexia (3). Conclusions: The once in a year use of zoledronic acid infusion for osteoporosis in postmenopausal women was not associated with a statistically significant renal and hepatic adverse effects. Among the biochemical parameters evaluated, only serum calcium level decreased slightly and statistically significantly after using zoledronic acid infusion, despite prophylactic calcium use before treatment.Amaç: Kemik metastazlı kanser hastalarında uygulanan zoledronik asit sonrası renal toksite ve hipokalsemi sık rastlanan olumsuz yan etkilerdir. Postmenapozal osteoporozlu hastalarda ise zoledronik asit infuzyonu ile oluşabilecek bu yan etkiler açısından yetersiz veri mevcuttur. Bu çalışma ile amacımız, postmenapozal osteoporozlu hastalarda yıllık zoledronik asit uygulaması sonrası hepatik ve renal fonksiyonları incelemektir. Aynı anda bu ilacın uygulanması ile oluşabilcek biyokimyasal değişiklikleri de saptadık.Gereç ve Yöntem: Postmenapozal osteoporoz tanısı almış ve yıllık zoledronik asit (5 mg) infüzyonu uygulanan hastaları elektronik medikal kayıtlar üzerinden tarandı. Serumda ki kalsiyum,fosfor, alkalin fosfat, kreatinin, kan üre azotu, alanin ve aspartat transaminazlar bazal değerlere göre değişimi değerlendirildi ve yan etki (olumsuz) ile ilgili verilerde elektronik kayıt sistemleri kullanılarak tarandı.Bulgular: Klasiyum dışındaki tüm parametreler zoledronik asit uygulamasından önce ve sonra değerlendirildiğinde istatiksel olarak anlamlı değişiklik saptanmadı. Serum kalsiyum seviyesinde istatiksel olarak anlamlı şekilde azalma mevcuttu, uygulama öncesi 9,6±0,6 mg/dl ikne uygulama sonrası 9,4±0,9 mg/dl idi. Zoledronik asit uygulaması sonrası görülebilecek grip benzeri sendrom (6), myalji (4), artralji (4), baş ağrısı (4), kaşıntı (3) gibi yan etkilere rastlandı.Sonuç: Postmenapozal osteoporoz hastalarında kullanılan yıllık zoledronik asit infüzyonu renal ve hepatik yan etki açısından istatiksel olarak anlamsız bulunmuştur

Real-time sonoelastography findings in a patient with tennis leg: A promising technique in the assessment of muscle rupture

WOS: 000399965500017

Monoarticular hip involvement in pseudogout.

Pseudogout is the acutest form of arthritis in the elderly. Although clinical manifestations vary widely, polyarticular involvement is typical mimicking osteoarthritis or rheumatoid arthritis. Monoarticular involvement is relatively rare and is generally provoked by another medical condition. There are reported cases of hip involvement by pseudogout in monoarticular form. However, all of the cases were presented as septic arthritis. In this report, we present a case of monoarticular hip involvement mimicking soft tissue abscess. We confirmed the pseudogout diagnosis after ultrasonographic evaluation of the involved hip joint and pathological and biochemical analysis of synovial fluid analysis. Diagnosis is important to avoid unnecessary medical and surgical treatment in cases of the bizarre involvement of hip in pseudogout

The importance of patient compliance in nonunion of forearm fracture

INTRODUCTION: Studies on radius ulna shaft fractures are very important. Surgical treatment is generally administered due to the unstability caused by the dynamic effect of forearm muscles. Surgical technique, implant, osteoporosis, patient compliance can affect the surgical treatment and healing. PRESENTATION OF CASE: An 86-year-old female patient was admitted to emergency service with the complaint of protrusion of forearm implant from the skin. Physical examination revealed that 80° nonunion developed on the radial side. Therefore, protruded and exposed internal fixation materials were excised under axillary block. We used zoledronic acid as a treatment of osteoporosis with the value of −3.2 Dexa score. DISCUSSION: Complication rate is reported to be 25% in patients treated with plate fixation. Patient compliance is very crucial in forearm fractures as in all surgical procedures. Presence of comorbidities and socioeconomical status of the patient are important factors in fracture healing. CONCLUSION: This case emphasizes the importance of compliance of the patient to the follow-up after surgical treatment of forearm fracture

Hybrid external fixation via a minimally invasive method for tibial pilon fractures -Technical note

Introduction: We aimed to present the clinical and radiological outcomes of patients with tibial pilon fractures who were treated with hybrid external fixators. Shanz screws were applied synchronously and used as joysticks for fracture reduction. Radiological evaluations were conducted on roentgenograms at the second week, sixth week, third month and first year. Material and methods: The study group included 42 patients with tibial pilon fractures that were classified as 43C according to the AO/OTA classification system. We used 2-hydroxyapatite-coated Schanz screws for the tibial pilon reduction. Schanz screws fixated to two separate motors were synchronously passed through the fracture fragments. An external fixator was applied after the fracture was stabilized with Schanz screws. Results and discussion: The mean operation duration was 45 min Fracture healing was observed in all patients, and the mean fracture healing time was 17 (range, 12-32 weeks) weeks. The mean lateral distal tibial angle was 89°. Joint surface irregularity was not observed in any patient. All of the patients had 0-15° of ankle dorsiflexion. None of the patients had restricted ankle plantar flexion. No wound complications were observed. According to the AOFAS scoring system, the clinical evaluation was excellent in 26 patients, good in 14 patients and fair in 2 patients. Malunion and nonunion may necessitate additional surgical procedures, delay the return to activities of daily living, and increase treatment costs. Good alignment was achieved, with a mean lateral distal tibial angle of 89 (range, 84-92) degrees. Conclusion: Permanent hybrid external fixator applied using Schanz screws via a mini open technique is a fast, easily applied alternative with low morbidity and satisfying results